cardiovascular risk

Background and aim: Metabolic abnormalities are common in HIV/AIDS. Increasingly, lipid ratios are used as screening tools for dyslipidaemia in these medical conditions. The aim of this study was to assess the ability of 4 lipid ratios to predict cardiovascular risks. Methods: This is a cross-sectional and analytical study included 105 HIV+ patients followed in Kinshasa University Teaching Hospital (KUTH). Four indices [Atherogenic Index of Plasma (AIP), Castelli Risk Index (CRI) I and II, Atherogenic coefficient (AC)] were compared. Statistical analyzis consisted of measuring frequencies and means, Student’s t-tests, ANOVA and Ficher’s exact test, and the calculation of the Kappa value. Results: Lipid ratios predicted respectively the risk in 62% (AIP), 28.6% (CRI-I) and 23.8% (CRI-II). CRI-I and II were elevated, especially in women. The AIP appeared to be a better predictor than CRI-I and II to assess dyslipidaemia in general and the high-risk frequency. The cholesterol detected risk in 66.7% (Low HDL-C), 50% (High LDL-C), 38.9% (High TC and/or TG). The atherogenic risk was higher with age, advanced WHO stage, HIV-TB, HBV-HCV co-infections, smoking and alcohol intake. Haemoglobin (Hb) and CD4 counts were low when the risk was high. Age ≥ 50 years, stage 4 (WHO), CD4s+ ≤ 200 cells/µL were independent factors associated with atherogenic risk. Conclusion: Lipid ratios can be used as reliable tools for assessing cardiovascular risk of naïve HIV-infected patients who received HAART.

Background: Schizophrenic patients have a lot higher smoking rates when compared to people in the general population. A variety of pharmaceutical cessation aids are available, which include nicotine replacement therapy (NRT), Bupropion SR, and Varenicline. Our objective was to assess which cessation medication would have lower risks in developing risk factors of cardiovascular diseases. Methods: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (1995-2011). The cohort consisted of patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-9 code 295.00-295.99) and who had newly initiated use of any smoking cessation medication. We excluded our cohort who (1) were not prescribed atypical antipsychotics and (2) already had diagnosis of diabetes, hyperlipidemia or hypertension prior to index date. Follow up period was from 12 weeks onwards index date up to one year. The hazard ratio of developing cardiovascular risks was assessed using Cox proportional hazards regression model after controlling for other covariates. Results: A total of 580 patients were included in our cohort. Among those, nearly half (n=276, 47.59%) developed one or more criteria of the metabolic syndromes. We found that smokers who were prescribed NRT were less likely to develop metabolic syndromes as compared to those who were prescribed Varenicline. Conclusions: Physicians are advised to carefully weigh the risks against the benefits before prescribing cessation medications since risks for metabolic syndromes were found to be very high. Healthcare providers should monitor patients’ lab data regularly as this minority population is under higher risks.

Several experimental studies performed since 1975, using smooth muscles richly innervated by sympathetic nerves to exclude the autonomic influence of adjusting reflex (rodent vas deferens), showed that L-type voltage-activated Ca2++ channels (VACC) blockers completely inhibited neurogenic contractions induced by electrical field stimulation (EFS) in high concentrations (>10-6 M), but paradoxically increased these EFS-contractions in low concentrations (<10-6 M), suggesting that other mechanisms than only autonomic adjusting reflex are involved in these paradoxical effects. In 2013, we showed that these paradoxical effects of L-type VACC blockers, named by us “calcium paradox” phenomenon, were potentiated by drugs which increase cytosolic cAMP concentration ([cAMP] c-enhancers), such as rolipram, IBMX and forskolin, indicating that this sympathetic hyperactivity drug-induced is due to interaction of the Ca2+/cAMP intracellular signaling pathways (Ca2+/cAMP interaction). Then, the pharmacological manipulation of this interaction produced by combination of the L-type VACC blockers used in the antihypertensive therapy, and [cAMP] c-enhancers used in the antidepressive therapy, could represent a potential cardiovascular risk for hypertensive patients due to sympathetic hyperactivity. Then, we discussed the role of Ca2+/cAMP interaction for antihypertensive pharmacotherapy.

Hypertension remains the most common modifiable cardiovascular risk factor, however, control of hypertension rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve the control of hypertension. Home BP monitoring is now defended evenly for the evaluation and management of hypertension. This paper shows the experience of the National Association of Mexican Cardiologist in a group of patients with hypertension under drug treatment to evaluate the control in a real world clinical practice in Mexico. One hundred and fifty one patients were included. They were followed during two weeks with three home measurements at day (8:00, 14:00 and 20:00hr). An Ambulatory blood pressure of 24hr was performed at the middle of study. At the end of the study 36% (54/151) patients still uncontrolled by systolic blood pressure (>135 mmHg) and 31% by diastolic blood pressure similar results were detected by ambulatory blood pressure. During afternoon and night uncontrolled values were more common. Home blood pressure monitoring, results in a better form to detect uncontrolled patients and help clinical judgment to adjust pharmacological therapy. This practice should be recommended in Mexico.

The new report of American College of Cardiology/American Heart Association task force on Clinical Practice Guidelines for High Blood Pressure in Adults was published online ahead of print November 13, 2017. The new American recommendation was focused on the criteria to define Hypertension. 130/80 mmHg or more is now considered as the new cut off point to define Hypertension. It is not new if we consider cumulative evidence in the las two decades has been broken the idea to consider 140/90 mmHg as the point to start medical actions. Thus, in México with current ACC/AHA definition it is estimated today around 48 million of adult hypertensive population. In the Mexican Institute of Social Security (IMSS) several strategies has been developed to improve prevention as the key action to confront non communicable chronic disease including hypertension. This updated guideline from ACC/AHA is an extraordinary opportunity to reinforce our preventive programs to high blood pressure control. In this brief report we analyze the epidemiological situation in Mexico and its possible consequences of the new criteria for hypertension diagnosis. The main current strategies that are applied into the IMSS to confront cardiovascular risk factors are directed to prevention. The IMSS is prepared to attend situations as the change of criteria diagnoses in Hypertension and new preventive models are in progression.

Atherosclerotic cardiovascular disease (ASCVD) is globally defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin and it is the leading cause of morbidity and mortality for individuals with or without diabetes and is the largest contributor to the direct and indirect catastrophic costs of cardiovascular disorder. Very common conditions coexisting into the cardiovascular risk (e.g., obesity, hypertension, diabetes and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Numerous studies have shown the efficacy of controlling individual cardiovascular risk factors in preventing or slowing ASCVD in people with these disorders. In other words it is not enough control one risk factor. We need to develop novel strategies to detect and control all of them at the same time. Thus, large benefits are seen when multiple cardiovascular risk factors are addressed simultaneously. Under the current paradigm of aggressive risk factor modification in patients with cardiovascular risk, there is evidence that measures of 10-year coronary heart disease (CHD) risk among U.S. adults with cardiovascular risk have improved significantly over the past decade and that ASCVD morbidity and mortality have decreased. In Mexico the Mexican Institute of Social Security is implementing new strategies of primary and secondary prevention in order to confront this pandemic. In this review, we analyze the state of the art to approach at the same time the different cardiovascular risk factors, in an integral form because of this is the real worldwide challenge of health.

Background: Several epidemiologic studies indicate that up to 50% of patients with heart failure have a preserved ejection fraction, and this proportion has increased over time. The knowledge of its severity and associated comorbidity is determining factor to develop adequate strategies for its treatment and prevention. This study was focus on the creation of a cohort and follow-up of Mexican population and to analyze its severity as well as its interaction with the comorbidity of other cardiovascular risk factors. Methods: We included patients from different sites of Mexico City than were sent to the Cardiology hospital of the National Medical Center in Mexico City for the realization of an echocardiogram as part of their assessment by the presence of dyspnea, edema, or suspicion of hypertensive heart disease. Complete medical history, physical examination and laboratory studies including Brain Natriuretic Peptide (BNP) serum levels were performed. Diagnosis of diastolic dysfunction was based on symptoms and echocardiographic data including time of deceleration, size of left atrium, e´ septal and e´ lateral, as well as E wave, A wave and its ratio E/A. All patients had left ventricle ejection fraction > 45%. Results: We included 168 patients with HFpEF. The most common risk factor was hypertension (89.2%), followed by overweight and obesity (> 78.5%), dyslipidemia (82.1%) and diabetes (42.8%). Women were dominant, 108 (64.3%); the mean age was 63 years old. When we classify by severity of diastolic dysfunction, we found that 41.1% were grade I, 57.1% were grade II and only 1.8% were grade III. The risk factors most strongly associated with the severity of diastolic dysfunction were hypertension, obesity and dyslipidemia. We found BNP levels highly variables, but the levels were higher detected as the ejection fraction was approaching to 45%. At one year of follow up mortality was not reported. Conclusion: HFpEF is a frequent entity in patients with cardiovascular risk factors in Mexico. The most common risk factor was hypertension. The combination of hypertension, overweight and dyslipidemia predicted the severity of diastolic dysfunction. We recommend that all Mexican patient with hypertension and overweight or obesity should be submitted as a part of its medical evaluation to an echocardiogram study in order to detect diastolic dysfunction even though the signs or symptoms are or not evident.

Today, Mexico has more than 130 million inhabitants; 85 millions of them are adults of 20 or more years old. The population pyramid is still one of base wider and this base corresponds to adults younger than 54 years old. Despite predictions made 20 years ago, about a transformation of the population pyramid shape to a mushroom shape as a consequence of more life expected and adult population growth; this change has not been occurred. Hypertension has become the biggest challenge of noncommunicable chronic diseases to public health in Mexico. Around 30% of adult Mexican population has hypertension; 75% of them have less than 54 years old (in productive age); 40% of them are unaware but only 50% of aware hypertensive population takes drugs and, 50% of them are controlled (< 140/90 mmHg). Cardiovascular risk factors including hypertension, dyslipidemia, obesity, and diabetes often cohabit in the same person and are magnified one to another in terms of common pathophysiological pathways. Atherosclerosis, arrhythmias, stroke and heart failure are common and are the final pathologic end-points and explains why cardiovascular diseases occupy first place in mortality in Mexico and worldwide. The costs of care for these diseases are billionaires and if we do not generate appropriate strategies, their global impact can become a high threat to social development of the country. The life style like nutrition, sports habits of the Mexicans must be emphasized; there is poor education about this crucial topic. This position paper is focused on the principal controversies and strategies to be developed by all, government, society, physicians, nurses, patients and all people related with healthcare of hypertension, in order to confront this huge public health problem in Mexico.

Introduction: High blood pressure is a major cardiovascular risk factor. In hypertension, non-compliance is frequent. The objective of this work is to evaluate the therapeutic observances and to identify the predictive factors of poor compliances in Chadian hypertensive patients. Patients and Methods: It was a prospective cross-sectional study over a six-month period from January 15 to July 15, 2019. This was performed in the outpatient Cardiology and Nephrology units at the Renaissance Hospital of N’Djamena. We included all follow-up patients who had hypertension who consulted during the study period. However, dialysis patients and children were excluded from this study. The parameters studied were demographic characteristics, economic and therapeutic data and the rate of therapeutic compliance. Results: Eighty-seven patients were included. The average age was 50 years old. The sex ratio was 2.5. Sixty-seven percent (n = 58) of the patients were from urban areas. The predominant cardiovascular risk factors were smoking in 25% (n = 22) and diabetes in 23% (n = 20). Hypertension was uncontrolled in 76% (n = 66) patients. Adherence was poor in 66% (n = 57) of patients. The monthly cost of treatment was respectively 10,000 and 20,000 FCFA in 52% (n = 45) of cases. Combination therapy was observed in 70% of cases (n = 61) and 56% (n = 49) of patients had more than one drug intake. The adherence rate was 93% (n = 28) in the urban population (p < 0.001). All patients (n = 30) who were observing their treatment were educated (p < 0.001). The adherence rate was 20% (n = 6) in patients who had a monthly income less than 100,000 FCFA (p = 0.004). The adherence rate was 60% (n = 18) when the monthly cost was less than FCFA 10,000 (p = 0.003). The adherence rate was 77% (n = 23) in patients receiving monotherapy (p < 0.001). Conclusion: This study showed a low level of adherence in Chadian hypertensive patients. The complexity and cost of antihypertensive therapy, poor knowledge of hypertension, and ignorance of its severity have been the main factors of poor compliance.

Background: Cerebral small vessel disease and extracranial atherosclerotic carotid disease are manifestations of silent cerebrovascular disease (CVD). Information on these two pathologies in hypertensive population with low cardiovascular risk (CVR) is scarce. Objective: To explore frequency and characteristics of silent CVD in hypertensive adults and cognitive repercussion of these alterations. Methods: 39 hypertensive patients (mean age: 53.5 years) were studied. Cerebral magnetic resonance imaging (3T), doppler ultrasound of the carotid artery and neuropsychological studies were obtained. Results: 79% of patients presented white matter lesions (WML), 18% showed only cerebral atrophy and/or enlarged perivascular spaces, 60% presented hyperplasia of intimal media complex (IMC) and/or atheroma plaques. In women, a significant correlation was observed between IMC thickness and bifrontal index, and WML was greater in patients with carotid plaques. A non-significant decrease in neuropsychological performance was observed in the groups of patients with intra and/or extracerebral injury and a negative correlation with the bifrontal index in men was found. Conclusion: Frequency of intra and extracerebral silent CVD was high in hypertensive adults with low to moderate CVR. WML and brain atrophy were partially related with carotid lesions. Age significantly influenced the appearance of intra and extracerebral lesions. Cognitive performance did not decrease significantly due to the presence of these lesions.

Introduction: Obesity defined as increased fatty mass is progressively rising in recently, even though its affects begins to all systems in childhood and adolescence periods, the most important morbidity and mortality reason of obesity is its effects on the cardiovascular system. Researches point out endothelial dysfunction and atherosclerosis as the reason of the cardiovascular system disease in obesity. The studies conducted on childhood period related to this subject are highly limited and the results of these are also controversial. Therefore in our study the effects of obesity on endothelial functions in children and adolescents was assessed by flow mediated dilation (FMD) method. In addition to that, effects of epidemiological, biochemical, hormonal and clinical features of cases to FMD were investigated. Material and method: A total number of 104 cases were cover in this study. Obese group (group 1) was consisted of 59 children whose body mass index (BMI) was ≥ 95th percentile and mean age was 12 ± 2.8 years old. The control group (group 2) consisted of 45 children whose body mass index (BMI) was between 25th -84th percentil and mean age was 11.4 ± 2.9 years old. The detailed history, epidemiological data and physical examination were performed. The population classified three groups according to sport activities. 97th percentile and higher values were accepted as morbid obesity. The blood pressure was measured with a mercury sphygmomanometer with utilizing the proper size cuff in compliance with the criterion used by the “National High Blood Pressure Education Program Working Group”. The complete blood count and biochemistry tests (renal and liver function tests, electrolytes, lipids, hsCRP) of the cases were analysed with biochemistry Roche Cobas Integra 800 and hormon assays of the cases (thyroid function tests, diurnal cortisol, ACTH, 17 OHP, prolactin, DHEA-S) were analysed by ECLIA method on Roche Elecsys 2010 device in the laboratory of our hospital. IR-HOMA values > 2.5 in prepuberal and > 4 in pubertal were defined as the insulin resistance. Bone ages of cases were evaluated with left hand wrist X-ray by using Greulich and Pyle Bone Age Atlas. flow mediated dilation (FMD) was used to assess the endothelial functions of all cases. The brachial artery was evaluated with SPG 12 MHz surface probes by using GE voluson ultrasound system in this method. FMD was expresses as percent (%) increase according to the basal vein dimension. 7% mean value was taken as the limit in the comparisons. Results: The ratio of male and female was 20/39 in group 1 and 14/31 in group 2. 32.3% of the cases in group 1 and 47.6% of the cases in group 2 were prepubertal. The waist and hip circumferences ratio of the group 1 (0.86 ± 0.05) was significantly higher than group 2 (0.80 ± 0.07). While there was no difference between groups 1 and 2 in terms of the birth weight, using duration period of vitamin D and beginning time to additional nutrition, breastfeeding duration of group 1 (10.6 ± 7.8 months) was significantly shorter than group 2 (14 ± 7.4 months). BMIs of the mothers in group 1 were statistically higher than the mothers in group 2 (27.5 ± 4.8 kg/m² and 24.3 ± 3.2 kg/m² respectively. The mean of IR-HOMA was 4 ± 2.9 in group 1 and 1.9 ± 0.8 in group 2 and there was the insulin resistance in 51% of the obese cases. The dyslipidemia was diagnosed in 38.5% of the cases in group 1. The systolic and diastolic blood pressures in group 1 (117 ± 12.2 mmHg and 73.7 ± 9.4 mmHg respectively) were significantly higher than in group 2 (107.5 ± 9.1 mmHg and 68.2 ± 7.1 mmHg respectively). Hypertension was determined in 25% of the cases included in group 1. The minimum values of FMD in groups 1 and 2 were 1.01% and 3.1% respectively. The maximum values of FMD in groups 1 and 2 were 9.7% and 15% respectively. The mean values of FMD was %5 ± 2.3 in group 1 and %8.1 ± 3.5 in group 2. Compared with group 2, group 1 demonstrated significantly impaired FMD. There was no association between FMD and the birth weight, breastfeeding duration, physical exercises in two groups. A negative correlation was found between FMD and BMI (p < 0.01, r = -0.402). The correlation was determined between FMD and BMI of the mother (p = 0.017, r = -0.305) and the presence of obese individuals in the family (p = 0.021, r =-0.413). It was found that a significant negative correlation between FMD and waist-hip circumference ratio (p = 0.003, r = -0.421). When each groups were assessed in terms of biochemical and hormonal characteristics, there was low negative correlation between FMD and uric acid level and strong negative correlation between FMD and ALT level were determined in group 1. Conclusion: In our study showed that the obesity begins in the childhood period may cause to the endothelial dysfunction. For this reason, according to our opinion, recognition prior indicators of endothelial dysfunction in early time may be helpful both to take the precautions required and to prevent cardiovascular complications in childhood and influences to the adult period. The rising sizes of the waist and hip circumferences, positive family history for obesity and obesity of the parents were determined as the most important parameters negative affecting FMD. Unlike the literature, the association between endothelial dysfunction and GGT level the indicator of the hepatosteatosis in obese children was also found as well as FMD and ALT have also a close association independent from BMI in this study. Thus, a different point of view was formed since ALT may possibly have a predictor value in the assessment of the endothelial functions and it is also found as a highlighted risk factors for the endothelial dysfunction in this study. Because of this reason, it can be recommended that when the liver function tests carry out in obese children it does not show only hepatosteatosis but also can be used as an early indicator of the cardiovascular complications of obesity. Another important subject to be emphasize that the ALT level in the childhood period may be an early cardiovascular risk indicator in both obese and nonobese children.

Alopecia is associated with an increased risk of coronary heart disease, and it appears that there is a relationship between the degree of hair loss and the risk of coronary heart disease, meaning, the greater the severity of alopecia, the greater the risk of coronary heart disease. Alopecia is also associated with an increased risk of hypertension, hyperinsulinemia, insulin resistance, metabolic syndrome as well as elevated serum total cholesterol and triglyceride levels. It has not been definitively established whether patients with androgenetic alopecia have a higher cardiovascular risk or prevalence of metabolic syndrome, and results of recent studies indicate that androgenetic alopecia patients do not show differences in insulin resistance or the prevalence of metabolic syndrome. However, androgenetic alopecia patients do show a higher cardiovascular risk, characterised by increased inflammatory parameters and Lp(a) levels. Data collected from female populations are scarce, but it would be interesting to extend our clinical knowledge with this type of data to further our understanding of the connection between androgenetic alopecia, metabolic syndrome and cardiovascular risk. The divergence in results from different studies done in this context may simply be a result of the composition of the study populations with respect to age, gender, severity of alopecia, sample size and perhaps ethnicity. In this connection, a large group of androgenetic alopecia patients is necessary, including different representative groups and varying severities of alopecia. Furthermore, it is recommended that all women and men with androgenetic alopecia be thoroughly examined and that lifestyle changes are made early on to reduce the risk of various problems associated with metabolic syndrome, since androgenetic alopecia can be considered an early marker of metabolic syndrome.

Metabolic syndrome composed of abdominal obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance and/or glucose intolerance, proinflammatory state and prothrombotic state is a complex multisystem disorder. It is well known that patients with metabolic syndrome have increased cardiovascular risk and risk of developing diabetes type II. But besides these well known risk states, there are other conditions such as polycystic ovary syndrome, fatty liver, cholesterol gallstones, asthma, sleep disturbances and some forms of cancer associated with a metabolic syndrome. In this case report we will present a patient who developed many of these conditions related to the metabolic syndrome and will highlight the novel efforts regarding to the lifestyle changes, primarily weight loss.

Background: Obesity is a significant health risk linked to hypertension and heart-related disorders in adolescents, impacting their future well-being . Since, the present work is to determine the body constitute including percentage of body fat correlates with cholesterol level which associate with Body Mass Index. Methods: This cross-sectional work was held in 120 college girls aged 19-23 years of Bhavan’s Tripura College of Science and Technology, Anandanagar at West Tripura. Anthropometric measurements such as standing height, body weight, sub scapular and triceps skinfolds, waist &hip circumference were collected. These records were used to calculate Body Fat Percentage (%BF) and Fat Mass (FM). Waist and Hip ratio (WHR) and Body Mass Index (BMI). FM, %BF and biochemical studies such as serum cholesterol level were also used to measures the body fat composition. Results: According to the present study, 53.33% of girls have a normal BMI, 8.83% are underweight, 31.67% are overweight, and 6.67% are obese. WHR results indicate that 54.17% of participants are classified as obese and 45.83% as non-obese. Out of 114 (95%) girls with normal cholesterol levels of 16 (13.33%) students are pre-hypertensive and 10 (8.33%) students are hypertensive. Out of 38 overweight and 8 obese students 13.34% are in pre or hypertensive. Based on WHR, 65 (54.17%) female students are obese; out of 65 obese students, 12 (10%) and 7 (5.83%) female students are pre-hypertensive and hypertensive, respectively and this value is statistically significant (p value < 0.05). Out of 55 (45.83%) no-obese students 8 (6.67%) girls are pre-hypertensive and 5 (6.67%) girls are hypertensive. According to BMI female students who are overweight or obese (5%) also have excessive blood cholesterol.Conclusion: This study expressed clear evidence of correlation in BMI, serum cholesterol level and Hypertension. These results are important for epidemiological studies to identify the cardiovascular risk in obese adults and help to solve a health problem of present Youngers in their future life. This study serves as an early health warning for female college students.